Medical Futility

Abstract

Abstract Medical futility is a concept that has been heavily debated since the late 1980s. It is increasingly invoked in end‐of‐life decision‐making as a way to both describe certain situations and to justify refusing treatment as a response to those situations. As the emphasis on patient autonomy has grown, so have demands for treatment that the medical team thinks are inappropriate because they are insufficiently beneficial. The concept of medical futility addresses these treatment demands. Futility judgments have been categorised as physiologic, quantitative and qualitative depending upon the nature of the claim being made. Despite an ongoing dialogue about the nature of these judgments, there is still widespread disagreement about the appropriate use of the concept as a justification for limiting treatment. Key Concepts: Medical futility is a concept used both to describe certain treatment and as a justification for refusing certain treatment. There is significant disagreement about exactly what medical futility means, in what situations it should be applied, and what justification it ultimately provides for refusing treatment. Medical futility can usefully be distinguished into physiological, quantitative and qualitative futility. The debate over medical futility can be seen as arising from several factors: the development of modern technology, the rise of patient autonomy as a dominant value in Western medicine, and growing concern with cost control. Medical futility can only be determined relative to particular goals and futility judgments require us to consider what we think the appropriate function and goals of medicine should be. Institutional policies about medical futility generally focus on fair procedures for resolving futility disagreements rather than on a universal definition.